Preliminary Pressure Ulcer Risk Assessment (PPURA)
The PPURA can be used at the point of admission to a care area
and can also be incorporated into the daily care regime of
patients/clients who are not identified to be at risk.
Key points to remember:
- Pressure ulcer prevention is everyone’s business.
- This tool can help you save time. It helps you to identify
those clearly at risk of developing a pressure ulcer and screens
out those not at risk - fast.
- It focuses on a collection of factors which we know lead to
- Use with your judgement and knowledge of the
- Risks change, people change, so consider using this quick tool
on a daily basis or when there is a change in circumstances or
- If this tool suggests the person is at risk, consider a more
detailed assessment, and follow up with action.
- If you are not confident in using this tool - ASK
This is a tool to help you identify
easily and swiftly those at risk of developing a pressure
It does this by focusing on a collection of factors that are
known to impact on an individual’s risk of developing a pressure
ulcer. You as a care provider are of course encouraged to use your
clinical judgment and your knowledge of individual patients/clients
to support this assessment.
How was this tool developed?
This tool was developed by an expert group in Scotland as part
of the National Tissue Viability programme. As with all the work on
this website, we have also drawn on expertise outside Scotland.
First, we identified a collection of risk factors through a
2-round method of consensus with Scotland’s Tissue Viability Nurse
Experts. We then mapped these factors to those identified by an
extensive systematic literature search undertaken by Professor Jane
Nixon and colleagues at the University of Leeds. This work helped
us isolate a collection of factors which are important in
identifying risk of developing a pressure ulcer. These factors were
further considered by an expert group who agreed on the same list
of important factors. Professor Nixon has been very supportive of
our work and has been constructive in her comments on the tool
during the consultation stage. Professor Andrea Nelson (University
of Leeds) contributed to our working group and was helpful in her
advice and support as the tool was developed and tested using
improvement methodology. In addition, we drew on the expertise of
Dr Michael Clark, professional advisor to the Tissue Viability
Society and Trustee of the European Pressure Ulcer Advisory Panel
Following initial work in identifying these factors there was
much discussion in the expert group on how the elements of the tool
should be presented. Changes were made to the tool’s design in
response to comments made during the consultation and testing
process. The resulting tool is designed to be easily
photocopied, and clipped into the patient/client notes. It is
designed to be easily completed every day or when there is a change
in circumstances or condition.
We have also drawn on work in Wales where we identified an area
of best practice in pressure ulcer prevention. Mr Hamish Laing and
the team at ABM University Health Board, South Wales have carried
out extensive work in pressure ulcer prevention using a care bundle
approach. The bundle comprises a set of evidence-based actions
which, if undertaken together, minimise the occurrence of a
pressure ulcer. The care giver starts to use the care bundle if an
individual is judged to be at risk or has a pressure
As part of our innovation stream of work (Autumn
2010) we are currently conducting small tests of change with
this risk assessment to see if it can lead straight to the care
bundle without further assessment.
Some questions and answers:
Why another risk assessment tool?
This tool is to be used as an initial risk assessment tool. It
is designed to swiftly identify those clearly at risk of developing
a pressure ulcer and screen out those not at risk.
This tool is best considered as ‘upstream’ from the Braden and
Waterlow assessments - these are extensive multifactorial
assessments which you could use once someone has been identified as
‘at risk’ and if you need more detail on their circumstances. In
general, however, you can move straight to implementing the care
bundle if the risk assessment shows the patient/client to be at
What if the preliminary pressure ulcer risk assessment
tool suggests a person is at risk of developing a pressure
A full pressure ulcer risk assessment should be undertaken and
consideration should also be given to other
What can I do for my patient/client to minimise a
pressure ulcer occurring?
Use the care bundle to act swiftly to minimise risk and give the
right care at the right time.
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Published Date: 08/06/2010